UNDERSTANDING DERMATOPHAGIA: CAUSES, RISK FACTORS, SYMPTOMS, TREATMENT AND MORE

Dermatophagia is a body-focused repetitive behavior (BFRB) that involves biting or chewing the skin, nails, or cuticles. It is classified as an obsessive-compulsive disorder (OCD) related disorder that may lead to complications if left untreated.

This article will explore what dermatophagia is, its causes, symptoms, and treatment options.

What is Dermatophagia?

Dermatophagia, a type of BFRB, derives from the Greek words "derma" meaning skin and "phagia" meaning to eat. BFRBs are conditions that involve repetitive behaviors focused on the body^[1], often resulting in physical harm. According to research, as many as 1 in 20 people have a BFRB^[2]. Some are compulsive, and the person performing them is aware of their actions, yet unable to stop. They often promote a sense of pleasure and pain that alleviates tension, boredom, or some other negative emotion.

Dermatophagia and other BFRBs were formally discovered in 1948 by Dr. Marion B. Sulzberger and Dr. Sadie H. Zaidens. They originally named those with the condition "wolf-biters" after observing similar behavior in trapped wolves^[3]. Other names for dermatophagia include dermatodaxia and autocannabilism^[4].

People with dermatophagia have an uncontrollable urge to bite or chew the skin around their fingers, lips, or other body areas. This behavior also extends to biting or chewing nails, cuticles, or hair.

Is Dermatophagia a Form of OCD?

While dermatophagia is classified as a type of OCD, it is also considered a separate disorder. Intrusive thoughts and repetitive behaviors characterize OCD. Dermatophagia primarily focuses on the urge to bite or chew the skin. As this happens continuously and is often compulsive, it falls under the same category.

However, people with dermatophagia may also experience obsessive thoughts about their skin or the urge to bite, which can lead to a cycle of compulsive behavior. These shared symptoms make it problematic to distinguish between the two disorders.

Causes and Risk Factors

What causes dermatophagia is unknown. It appears to be a coping mechanism for stress, anxiety or related to another underlying mental health condition such as depression or primary OCD.^[5]

As seen in other BFRBs, it may also be linked to reward pathways in the brain^[6], where biting or chewing provides relief, gratification, or pleasure. Other brain areas include the cerebellum, the sensorimotor cortex, the limbic network, and the prefrontal cortex. These may perpetuate obsessive-compulsive behavior^[7], the inability to stop, and the emotional relief experienced in response to chewing or biting.^[8]

There is a slightly higher prevalence of dermatophagia in women than in men^[9]. The condition tends to begin at puberty^[10]. It is widespread in those who bite their nails. The urge may arise due to sensory stimulation when the areas feel different due to loose skin or a scab.^[11]

Dermatophagia can affect anyone, yet certain risk factors may raise the odds of developing the disorder. These include:

• Family history or a first-degree relative with a BFRB or OCD
• High levels of stress or anxiety
• Other mental health conditions, such as body dysmorphic disorders or anxiety disorders
• Perfectionism or high levels of self-criticism

Types of Dermatophagia

Dermatophagia itself is not categorized into different types. It is a body-focused repetitive behavior (BFRB) where someone compulsively bites or chews their skin. However, the areas targeted can vary depending on the individual.

Here is a breakdown of the commonly targeted areas:

• Fingers and fingernails: This is the most common area affected by dermatophagia. People with this might bite their cuticles, fingertips, or around their nails. Common complications include bleeding, sores, and even nail infections.
• Knuckles and Hands: Some people with the condition chew and suck on their knuckles or other areas of their hands and fingers. This behavior can cause the skin to harden and develop a biting callus.
• Lips: Lip biting is another common area that can cause the lips to become chapped, cracked, and bleed.
• Cheeks: Cheek biting is less common than in other areas. It can cause sores and irritation on the inside of the cheeks.

It is important to note that dermatophagia can affect any body area. If you are concerned that you or someone you know may have dermatophagia, it is necessary to visit a doctor or mental health professional for a swift diagnosis and treatment.

Other Types of BFRB

Dermatophagia is not the only type of BFRB. Other common BFRBs include:

• Trichotillomania: A disorder that refers to incessant hair pulling and removal from out of the scalp, eyebrows, or other body parts. It couples with feelings of tension or anxiety and can lead to severe hair loss and damage to the skin.
• Dermatillomania: Also known as skin-picking disorder, this is characterized by repetitive skin picking that can lead to scarring, infection, and damage to the skin.
• Onychophagia: This disorder involves biting or chewing the nails. It is similar to nail biting in dermatophagia, but it is considered a separate disorder.

Symptoms and Complications

The most common symptoms of dermatophagia include:

• Uncontrollable urge to bite or chew the skin, nails, or hair
• Feeling tensed or anxious before biting or chewing
• Relief or pleasure after biting or chewing
• Bleeding, scarring, swelling, or infection from biting or chewing
• Difficulty stopping the behavior

If left untreated, dermatophagia can lead to complications which can sometimes be serious, including:

• Infection from open wounds
• Damage to the skin, nails, or hair
• Social isolation and embarrassment
• Low self-esteem and body image issues
• Interference with daily activities and relationships

Dermatophagia Treatment

Dermatophagia is a treatable disorder, and there are various treatment options available. The most effective treatment approach combines therapy, medication, and self-care strategies.

As not every treatment is beneficial for every case, those wanting to treat their condition may need to try a few techniques to find what works.

Psychotherapy: Psychotherapy can help treat underlying mental health conditions that may contribute to dermatophagia. Types of therapy include individual therapy, group therapy, or family therapy.

Cognitive Behavioral Therapy (CBT): CBT is a type of psychotherapy that homes in on changing negative thought patterns and behaviors. It can effectively treat dermatophagia by helping individuals to develop awareness of their triggers and develop coping strategies to manage the urge to bite or chew.

One study suggests that CBT can help some patients with BFRBs to improve an aspect of working memory, which was lower before therapy began.

Habit Reversing Training: Habit reversing training is a therapy that involves identifying the specific behaviors associated with dermatophagia and replacing them with more positive behaviors. This training can include keeping hands busy with fidget toys or using relaxation techniques to manage stress and anxiety.

This training involves four steps^[12]:

• Awareness training: This helps you become more aware of the situations and triggers that lead to skin biting.
• Competing response practice: This involves practicing a different behavior to replace the skin biting, such as clenching your fists or fidgeting with a stress ball.
• Habit control motivation: This involves identifying the benefits of stopping skin biting and setting goals for yourself.
• Generalization training: This involves practicing your new behaviors in different situations.

Decoupling: This method involves diverting your attention from the urge to bite your skin and creating an unpleasant sensation or diversion to interrupt the behavior. One study found better success with visualization to interrupt the behavior.

Mindfulness: Mindfulness techniques, such as dedicated deep breathing and meditation, can help those affected to become more aware of their thoughts and behaviors. Drawing attention to the present can help them recognize triggers and manage the urge to bite or chew.

Medication: There are no official medications that treat BFRBs directly^[13]. In some cases, medication helps to manage symptoms of dermatophagia. Prescriptions can include antidepressants or anti-anxiety medication to help reduce the urge to bite or chew.

Skin Treatment: In addition to therapy and medication, addressing any physical damage caused by dermatophagia is important. Skin treatments may include treating open wounds, scarring, or infection.

How to Stop Dermatophagia?

If you are struggling with dermatophagia, there are steps you can take to manage the urge to bite or chew. These include:

• Ensuring your hands are busy with fidget toys or stress balls
• Using relaxation techniques, like deep breathing or meditation, to take control of stress and anxiety
• Keeping your nails well-trimmed to reduce the urge to bite or chew
• Wearing gloves, bandaids, foul-smelling ointments, or bandages on your fingers to prevent biting or chewing
• Replacing finger or skin chewing with skin nurturing activities, such as repairing the area with an ointment
• Seeking support from friends, family, or a therapist

Self-Care Strategies

In addition to professional therapies, there are several self-care strategies that can help individuals control their skin-biting habit.

Interestingly, the cerebellum, the part of the brain that governs movement, may contribute to BFRDs, and the disorder was first noted in wolves held in confinement. Regular physical activity may be one of the best remedies for BFRDs, including skin-picking disorder and dermatophagia.

Other tips to try include:

• Eating a healthy, balanced diet
• Getting plenty of sleep
• Practicing good hygiene to prevent infection
• Engaging in activities that bring joy and reduce stress
• Avoiding triggers, such as stress or boredom, that may lead to biting or chewing

Latest Research and Future Advancements

As technology continues to advance, there are new and innovative treatments underway for dermatophagia. These include:

• Teletherapy, also known as online therapy, allows anyone to receive instant therapy from the comfort of their homes^[14]. This remote therapy allows those who have difficulty accessing traditional therapy or who prefer the convenience of virtual sessions to benefit.
• Biofeedback is an awareness method that uses electronic sensors to oversee bodily functions, such as heart rate and muscle tension. This technique can help individuals with OCD and BFRDs to become more aware of their physical responses to stress and learn to manage them more effectively.^[15]
• Virtual reality therapy uses a simulated scenario in virtual reality to decondition the patient. This form of exposure therapy is proving helpful in treating anxiety disorders by exposing individuals to triggers in a controlled environment.^[16]

Conclusion

Dermatophagia is a severe disorder that can have a marked impact on the physical and mental well-being of affected individuals. It is helpful to seek professional treatment to manage symptoms and prevent complications. With the right combination of therapy, medication, and self-care strategies, individuals can learn to manage the urge to bite or chew and improve their overall quality of life.

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